Objectives: The present study aims to describe a 3-day induction protocol for injectable hydromorphone (HDM) and diacetylmorphine (DAM) used in 3 Canadian studies and examine rates of opioid-related overdose and somnolence during this induction phase.

Methods: The induction protocol and associated data on opioid-related overdose and somnolence are derived from 2 clinical trials and one cohort study conducted in Vancouver and Montreal (2005-2008; 2011-2014; 2014-2018). In this analysis, using the Medical Dictionary for Regulatory Activities coding system we report somnolence (ie, drowsiness, sleepiness, grogginess) and opioid overdose as adverse events. Read More

Background: Although methadone is an effective treatment for opioid use disorder, its initiation requires prescribing at a subtherapeutic dose with subsequent titration to a therapeutic dose over many weeks. Accordingly, the methadone induction period can be a challenging one for individuals and can be associated with an increased risk for ongoing illicit drug use and consequently overdose. Given its capacity for regular clinical assessments, acute care settings may offer a unique opportunity to reduce the duration of the induction period for methadone maintenance therapy. Read More

Objectives: The standard of care for treatment of alcohol withdrawal is symptom-triggered dosing of benzodiazepines using a withdrawal scale. Abbreviated scales are desired for clinician efficiency. The objective of this study was to evaluate the use of the 5-item Brief Alcohol Withdrawal Scale (BAWS) protocol. Read More

Background And Aims: Medication-overuse headache (MOH) is a common chronic headache caused by overuse of headache analgesics. It has similarities with substance dependence disorders. The treatment of choice for MOH is withdrawal of the offending analgesics. Read More

Objectives: This article describes how smartphones were used to monitor and encourage medication adherence in a pilot study evaluating the potential efficacy of a combination pharmacotherapy for methamphetamine use disorder. We examine the feasibility, utility, and acceptability of using smartphones to capture dosing videos from the perspectives of participants and staff.

Objective/background: Posttraumatic stress disorder (PTSD) and smoking are often comorbid. Combining PTSD and smoking cessation treatments could increase access to each treatment and could provide improved rates of smoking cessation through reductions in PTSD and depressive symptoms.

Participants: Participants were veterans with current PTSD who smoked cigarettes and were willing to initiate treatment for both problems. Read More

Objectives: Unhealthy alcohol use is associated with negative health outcomes in clients attending methadone maintenance therapy (MMT) programs. However, debates exist regarding the methadone dose of drinkers, and little is known about the health outcomes of drinkers with other types of alcohol use. This study examined the drinking pattern and its association with methadone dose, and depressive and anxiety symptoms in Chinese clients undergoing MMT. Read More

Authors:

British Columbia Centre on Substance Use (VB, SN); Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada (SN).

: Substance use disorders account for a significant burden of disease and place an enormous strain on the health care system in the United States and beyond. Despite death tolls climbing, a myriad of evidence-based medications exist to effectively treat many substance use disorders including nicotine, alcohol, and opioid use disorders. To date, hospitals have largely been overlooked as a setting ripe for the delivery of specialized addiction care. Read More

Background: While most opioid use disorder (OUD) treatment providers consider opioid abstinence to be the preferred outcome, little is known about the treatment preferences of the larger population of individuals who engage in nonmedical opioid use and have not yet sought treatment. This study sought to descriptively quantify the proportion of out-of-treatment individuals with nonmedical opioid use that have abstinent and nonabstinent recovery goals.

Methods: Participants (N = 235) who engage in nonmedical opioid use and met self-reported criteria for OUD were recruited online and participated in a cross-sectional survey on recovery goals and treatment perceptions. Read More

Objectives: To identify the incidence, characteristics, and predictors for 30 and 90-day readmission among acutely hospitalized patients with opioid use disorder (OUD).

Methods: This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period (10/1/11 to 9/30/16). Multivariable logistic regression was used to determine independent predictors for 30 and 90-day readmissions based on pertinent admission, hospital, and discharge variables collected via chart review and found to be different (with a P Read More

Authors:

Oregon Health & Science University (OHSU) and Portland State University School of Public Health (KCP, DM), School of Medicine, MD/PhD Program, OHSU (KCP), Department of Psychiatry, School of Medicine, OHSU, Portland, OR (DM).

Objective: The aim of the study was to explore and describe the structure and design elements of addiction medicine consult (AMC) services within selected US hospitals.

Methods: As part of a larger mixed methods study, 10 qualitative semi-structured telephone interviews were completed with board-certified addiction medicine physicians affiliated with the Addiction Medicine Foundation's Addiction Medicine Fellowship Programs at 9 US hospitals. Interviews were transcribed, coded, and analyzed using a directed content analysis. Read More

: Hospitals are increasingly filled with people admitted for medical and surgical complications of substance use disorder (SUD). Hospitalization can be a reachable moment to engage and initiate SUD care. Yet most hospitals do not have systems in place to adequately address addiction, and most providers have little to no addiction training. Read More

Authors:

School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil.

Objectives: Although there are a number of studies about substance use by medical students, the majority are still cross-sectional. We aimed to investigate prevalence, 2-year incidence, and factors associated with substance use during medical training.

Methods: This longitudinal study included medical students in 4 different waves (with each wave equaling 1 semester). Read More

Authors:

Institute for Gender, Race, Sexuality and Social Justice, University of British Columbia, British Columbia, Canada (AJL); School of Population and Public Health, University of British Columbia, British Columbia, Canada (AJL); British Columbia Centre on Substance Use, Vancouver, Canada (RK); Department of Medicine, University of British Columbia, Vancouver, Canada (RK).

: Epidemiological and clinical evidence clearly indicates that binge and/or heavy alcohol use while pregnant can be dangerous for the fetus. As such, there is a large body of research evaluating interventions to address harms associated with alcohol use during pregnancy. Unfortunately, based on our assessment of the scientific literature in this area, including a reading of three high-impact systematic reviews, there are several key areas where the language being used is hindering efforts to address alcohol harms during pregnancy in nonjudgmental and gender-inclusive ways. Read More

Objective: To assess the availability and price of naloxone as well as pharmacy staff knowledge of the standing order for naloxone in Pennsylvania pharmacies.

Methods: We conducted a telephone audit study from December 2016 to April 2017 in which staff from Pennsylvania pharmacies were surveyed to evaluate naloxone availability, staff understanding of the naloxone standing order, and out-of-pocket cost of naloxone.

Authors:

Department of Research, UNC Health Sciences at MAHEC; University of North Carolina-Asheville; Department of Family Medicine, Boston University School of Medicine (BO); UNC Health Sciences at MAHEC (CL).

Objectives: The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants' ambivalence about medication-assisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement.

Methods: We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. Read More

Objectives: Opioid misuse constitutes a significant public health problem and is associated with a host of negative outcomes. Despite efforts to curb this increasing epidemic, opioids remain the most widely prescribed class of medications. Prescription opioids are often used to treat chronic pain despite the risks associated with use, and chronic pain remains an important factor in understanding this epidemic. Read More

: Tianeptine is an atypical antidepressant which exerts an opioid-like effect on the μ-opioid receptor. There is well documented intentional misuse and addiction to tianeptine in Europe, and this is increasingly being seen in the United States. We presented a case of buprenorphine/naloxone successfully being used to aid in cessation and subsequent abstinence from tianeptine after years of use. Read More

Authors:

Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health (MJ); University of Pittsburgh School of Medicine (SM, CH); Magee-Womens Research Institute, University of Pittsburgh (JCC); Departments of Obstetrics, Gynecology and Reproductive Sciences and Internal Medicine, University of Pittsburgh, Pittsburgh, PA (JCC).

Objective: In many states, health care providers are legally required to report pregnant women who use substances, or infants affected by prenatal substance use, to child welfare authorities. The objective of this study was to characterize obstetric and pediatric providers' perceptions of and experiences with policies requiring mandatory reporting of prenatal substance use to child welfare authorities.

Methods: We conducted a qualitative interview study among 20 obstetric and pediatric providers to elicit participants' perspectives about and experience with current policy requiring mandatory reporting of prenatal substance use. Read More

Objectives: There has been a rapid increase in the presence of illicitly manufactured fentanyl in the heroin drug supply. Buprenorphine is an effective treatment for heroin and prescription opioid use disorder; however, little is known about treatment outcomes among people using fentanyl. We compared 6-month treatment retention and opioid abstinence among people initiating buprenorphine treatment who had toxicology positive for heroin compared to fentanyl at baseline. Read More

Objectives: Benzodiazepine (BZD) use is common in patients who are engaged in methadone as a treatment for opioid use disorder. BZD prescribing is generally discouraged for this patient population due to the increased risk of BZD dependence and BZD use disorder, medication-assisted treatment (MAT) discontinuation, and opioid-overdose death. However, some patients have concurrent mental health disorders, where BZD use may be clinically indicated. Read More

Authors:

Department of Pharmacology, College of Medicine, University of Kentucky, Lexington, KY (MAC, SLW); Department of Behavioral Science, University of Kentucky, Lexington, KY (MRL, SLW); and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY (MAC, MRL, SLW).

: Buprenorphine is an effective treatment for opioid use disorder. As a high-affinity, partial agonist for the mu-opioid receptor, buprenorphine suppresses opioid withdrawal and craving, reduces illicit opioid use, and blocks exogenous opioid effects including respiratory depression. Other pharmacologic benefits of buprenorphine are its superior safety profile compared with full opioid agonists and its long half-life that allows daily or less-than-daily dosing. Read More

: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder defined as low platelet count with normal bone marrow in the absence of other causes of thrombocytopenia. It is caused by autoantibodies binding to several platelet surface antigens which lead to premature destruction of the platelet by the reticuloendothelial system. ITP can be primary or secondary, and it is known to be associated with various infections and drugs. Read More

Introduction And Aims: Patients with opioid use disorder experience great challenges during acute pain management due to opioid tolerance or withdrawal symptoms. Previous studies have recommended the use of adjuvant drugs in these patients. In this study, we compared the effect of intraoperative lidocaine with ketamine in postoperative pain management of these patients. Read More

Authors:

Department of Clinical Pharmacy, College of Pharmacy (VB-M); Department of Pediatrics, Michigan Medicine, University of Michigan (VB-M, JS, RES); Department of Pharmacy, Ascension St. John Hospital, Ann Arbor, MI (JR).

Objective: The objective of this study was to compare short-term outcomes of neonatal opioid withdrawal syndrome (NOWS) treatment in infants exposed in-utero to opioids and selective serotonin reuptake inhibitors (SSRIs) or opioids alone.

Methods: This was a retrospective cohort study of mother-infant dyads, 34 weeks or greater gestation, receiving opioids and/or SSRIs during pregnancy. Intravenous or oral methadone was administered according to a pre-existing protocol for NOWS treatment guided by withdrawal scores. Read More

Objectives: Liberalization of marijuana laws in Colorado contributed to increases in cannabis-related adverse events over time. We examined characteristics of patients with healthcare encounters possibly related to cannabis and assessed the temporal association between legalization of recreational marijuana and healthcare encounters possibly attributed to cannabis.

Objective: Normative perceptions about substance use are well-established predictors of substance use risk behaviors, yet no research to date has examined how people who use heroin perceive the drug use behaviors and their association with personal behaviors. In a sample of persons seeking heroin withdrawal, we compared normative beliefs (descriptive norms) about others' drug use behaviors, and examined the association between normative beliefs and behaviors.

Authors:

Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas, NV (JJS); Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV (GS); Department of Health Care Administration and Policy, School of Community Health Science, University of Nevada, Las Vegas, NV (PCK); Department of Internal Medicine, UNLV School of Medicine, Las Vegas, NV (JWY); Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV (CD-F); Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea (YJL).

Objectives: To examine national trends and contributing factors of cannabis-associated emergency department visits in the United States.

Objectives: The postpartum period is a particularly challenging time for women in methadone treatment. Unfortunately, this is also the time when women are vulnerable to treatment discontinuation and opioid misuse. The purpose of the present exploratory study was to examine demographic, treatment, and delivery factors that may be associated with postbirth retention in treatment and opioid misuse. Read More

Objective: Prescription Drug Monitoring Programs (PDMPs) are intended to help reduce prescription drug misuse and opioid overdose, yet little is known about the longitudinal patterns of opioid prescribing that may be associated with mortality. This study investigated longitudinal opioid prescribing patterns among patients with opioid use disorder (OUD) and without OUD in relation to mortality using PDMP data.

Methods: Growth modeling was used to examine opioid prescription data from the California PDMP for a 4-year period before death or a comparable period ending in 2014 for those remaining from a sample of 7728 patients (2576 with OUD, and 5152 matched non-OUD controls) treated in a large healthcare system. Read More

Objectives: Due to the elevated rates of cigarette use and marijuana use within the criminal justice system, it is critical to develop a stronger understanding of tobacco and marijuana co-use among this population to inform future interventions.

Methods: This study is a secondary analysis of baseline data from a smoking cessation randomized clinical trial of adults (n = 500) in a community correction program. Participants were classified as using cigarettes only or both cigarettes and marijuana through either self-report or positive urine drug screening. Read More

Authors:

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT (LKM); Department of Obstetrics and Gynecology and the Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI (VD); Departments of Obstetrics and Gynecology and Psychiatry, Virginia Commonwealth University, Richmond, VA (MT).

Objectives: The aim of the study was to evaluate pregnancy intention, risk perception, and contraceptive utilization among women reporting substance use during pregnancy.

Methods: Data were obtained from the 2009 to 2011 Tennessee Pregnancy Risk Assessment Monitoring System (PRAMS), an annual cross-sectional survey which assesses behaviors before, during and after pregnancy. Substance use during pregnancy and contraceptive use at the time of conception and after delivery were captured by self-report in the postpartum period. Read More

Introduction: Catatonia is a syndrome that can present in different forms and can occur in multiple psychiatric and somatic conditions. This case report describes lethal catatonia caused by delayed toxic leukoencephalopathy after excessive use of cocaine and methadone. The characteristic radiographic imaging and biphasic course are discussed. Read More

: In this article, we describe a middle-aged woman with a history of addiction to opioid medications who eventually became dependent on kratom. Her kratom-related withdrawal symptoms responded to a trial of buprenorphine-naloxone. Subsequently, she was maintained on this medication. Read More

Authors:

: Fetal alcohol spectrum disorder is common and associated with economic costs greater than comparable other childhood and adult disorders. We need to turn our attention to prevention and mitigation. Read More

: This case report describes a patient with opioid use disorder who developed cardiac toxicity secondary to non-medical use of loperamide. At recommended doses, loperamide remains in the periphery to treat diarrhea. At high doses, loperamide causes central nervous system (CNS) opioid agonism. Read More

Objectives: Investigate patterns of methamphetamine use over time, specifically factors associated with remission from dependent and harmful patterns of use; and examine drug treatment and health/support service utilization pathways among people who use methamphetamine.

Methods: People who regularly use methamphetamine were recruited from nontreatment settings in Melbourne, Australia, in 2010, and followed up twice over 5 years. Trajectories of past-month methamphetamine use and methamphetamine dependence were mapped. Read More

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